Provider Demographics
NPI:1528080777
Name:GRIMALDI, NICHOLAS ANTHONY (DO)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ANTHONY
Last Name:GRIMALDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 OLD COMPASS RD
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-8604
Mailing Address - Country:US
Mailing Address - Phone:717-586-9936
Mailing Address - Fax:
Practice Address - Street 1:114 GATEWAY CORPORATE BLVD STE 240
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9785
Practice Address - Country:US
Practice Address - Phone:803-365-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND01840207X00000X
SCDO87813207X00000X, 207XS0117X
TNDO 1840207XS0117X
TNDO1840207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1729701OtherCIGNA HEALTHCARE
TN4299333OtherBCBS OF TENNESSEE
TNI60530Medicare UPIN
TN103I201903Medicare PIN